Accuracy of Diagnosing PDA, Neuroendocrine Tumors, and IPMN by EUS-FNA at a Single Institution

Abstract

PPV, and 89% (82-94) NPV. Detection of neuroendocrine tumors by FNA-EUS yielded 66% (47-87) sensitivity, 100% (97-100) specificity, 94% (71-99) PPV, and 97% (94-99) NPV. Detection of IPMN by FNA-EUS yielded 59% (43-74) sensitivity, 100% (98-100) specificity, 100% (87-100) PPV, and 89% (93-99) NPV. CONCLUSIONS: Our findings are largely consistent with the current literature, confirming there is discernible potential for inappropriate treatment of patients based purely on EUS-FNA evaluation. Both accuracy and clarity of positive tests with EUS-FNA worsened for mucinous pancreatic lesions compared to solid pancreatic lesions. Limitations of this study are the appraisal at a single institution and the necessity to evaluate only cases that ultimately had surgical resection of the pancreatic lesion. INTRODUCTIONPancreatic ductal adenocarcinoma (PDAC) has the 4th highest cancer mortality rate for both men and women in the United States. The average 5 year survival rate for PDAC patients with localized disease that were able to undergo a resection is approximately 24% [1] . Prognosis is poorer for the 80-85% of patients who are unable to undergo resection due to disseminated disease or ABSTRACT BACKGROUND: The purpose of this study was to assess the clinical impact of diagnostic accuracy for EUS-FNA in evaluating pancreatic lesions, particularly Pancreatic Ductal Adenocarcinoma( PDAC), neuroendocrine tumors, and IPMN at our institution using surgical pathological review as the gold standard. METHODS: We conducted a retrospective chart review using the Clinical Cancer Research Database at Huntsman Cancer Institute. We included all cases in which pancreatic lesions were evaluated by EUS-FNA and a subsequent surgical resection was performed. Sensitivity, specificity, positive predicative value (PPV), and negative predictive value (NPV) were determined for PDAC, neuroendocrine tumors, and IPMN by comparing pathological diagnosis at EUS-FNA to diagnoses following surgery. RESULTS: Detection of PDAC by FNA-EUS yielded 87.9% (80.1-93.4 95% CI) sensitivity, 80% (72-86) specificity, 78% (70-85)

Evaluation of the SharkCore® needle for EUS-guided core biopsy of pancreatic neuroendocrine tumors

“…In fact, NETs accounted for the most common cause of false-positive adenocarcinomas in this study. [ 10 ] It is worth noting that this study was performed before the introduction of the SharkCore ® needle at our institution.…”

“…By comparison, the detection rate for pancreatic adenocarcinomas was 88% over the same time period. [ 10 ] In addition, immunohistochemical staining of representative lesional material is often needed to make a definitive diagnostic interpretation for NETs because they share overlapping cytomorphologic features with acinar cell carcinoma, solid pseudopapillary neoplasm, pancreatoblastoma, and even adenocarcinoma. In reference to this, the Papanicolaou Society of Cytopathology Guidelines advises performing ancillary immunohistochemical stains not only for the cytologic diagnosis of pancreatic NETs but also to aid in awarding these tumors with an accurate grade (by Ki-67 index).…”

Endoscopic ultrasound-guided sampling of solid pancreatic masses: the fine needle aspiration or fine needle biopsy dilemma. Is the best needle yet to come?

“…Each of the 13 cases with definitive diagnosis showed adequate cell block material, used for ancillary testing, underpinning the need for robust cell block material to render a conclusive determination of pan-NENs. Conversely, in a recent 15-year retrospective study, 30% of false-positive EUS-FNA diagnoses of ADK were proved to be pan-NENs on the resected specimen[78]. The recent study by Witt et al[79] on patients with known or suspected pan-NENs compared EUS sampling with SharkCore ® in patients receiving EUS-FNA using a standard needle.…”